Quadratus Lumborum Block, Transversus Abdominis Plane Block, and Erector Spinae Block in Pediatric Abdominal Surgery

Comparing Quadratus Lumborum Block, Transversus Abdominis Plane Block, and Erector Spinae Block in Pediatric Abdominal Surgery

The aim of this study is to compare the analgesic efficacy and safety of Quadratus Lumborum (QL), Transversus Abdominis Plane (TAP), and Erector Spinae Plane (ESP) blocks in pediatric abdominal surgery.

Study Overview

• Status: Completed
• Conditions: Abdominal Surgery; Erector Spinae Plane Block; Quadratus Lumborum Block; Pediatric; Transversus Abdominis Plane Block
• Intervention / Treatment: Drug: Quadratus lumborum (QL) block; Drug: Transversus abdominis plane (TAP) block; Drug: Erector spinae plane (ESP) block

Detailed Description

Advances in perioperative care of children continue to be made with increasing evidence-based practice for postoperative analgesia. However, moderate to severe pain is still experienced by up to 40% of hospitalized children and specific high-risk populations or types of surgery continue to present challenges.

Transversus abdominis plane (TAP) block involves the injection of local anesthesia (LA) in between the transversus abdominis (TA) and internal oblique (IO) muscles.

The Erector Spinae Plane (ESP) block is most often performed using an in-plane ultrasound-guided technique. It is a paraspinal fascial plane block in which the needle placement is between the erector spinae muscle and the thoracic transverse processes, and a local anesthetic is administered, blocking the dorsal and ventral rami of the thoracic and abdominal spinal nerves.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • Menoufia
    • Shibīn al Kawm, Menoufia, Egypt, 32951
      • Menoufia University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 3 years to 12 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Children aged from 3 to12 years.
• Both sexes.
• American Society of Anesthesiologists (ASA) Physical Status I-II.
• Scheduled for pediatric abdominal surgery.

Exclusion Criteria:

• Allergy or contraindication to bupivacaine or dexmedetomidine.
• Coagulopathy.
• Local infection at the site of the block.
• Neurological or psychiatric disorders affecting pain perception.
• Refusal of the regional technique by parents/guardians.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: QL Group; Patients received quadratus lumborum (QL) block with bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg.	Drug: Quadratus lumborum (QL) block; Patients received quadratus lumborum (QL) block with bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg.; Other Names: Bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg
Experimental: TAP group; Patients received transversus abdominis plane (TAP) block with bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg	Drug: Transversus abdominis plane (TAP) block; Patients received transversus abdominis plane (TAP) block with bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg.; Other Names: Bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg
Experimental: ES Group; Patients received erector spinae plane (ESP) block with bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg.	Drug: Erector spinae plane (ESP) block; Patients received erector spinae plane (ESP) block with bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg.; Other Names: Bupivacaine 0.25% (0.5 ml/kg) + dexmedetomidine 0.5 mcg/kg

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Degree of pain	Degree of pain will be assessed using Wong-Baker FACES for the first 24 hours postoperative at 4, 8,12,16 and 24 hours postoperatively. Wong-Baker FACES Pain Scale, which utilizes a series of 6 faces increasing in pain severity may be used to facilitate communication and assist in pain assessment .	24 hours postoperatively

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total fentanyl consumption	If patient require analgesia during surgery (diagnosed by increasing heart rate and blood pressure) fentanyl 1mic/kg will be given, and total analgesic consumption will be calculated and recorded.	Intraoperatively
Heart rate	Heart rate will be recorded every 15 minutes till the end of surgery.	Till the end of surgery (Up to 2 hours)
Mean arterial blood pressure	Mean arterial blood pressure will be recorded every 15 minutes till the end of surgery.	Till the end of surgery (Up to 2 hours)
Time of each block	Time of each block will be recorded from using ultrasound probe till injection of local anaesthetic	Intraoperatively
Sedation score	Sedation score will be recorded at 0, 15 min ,30 min postoperative 0=no sedation (wide awake). =slightly sedated (easy to arouse) 2=moderately sedated(easy to arouse but cannot stay awake) 3=heavy sedated (difficult to arouse)	24 hours postoperatively
Time to first rescue analgesia	Time to first rescue analgesia will be recorded from the end of surgery till first dose of morphine administrated.	24 hours postoperatively
Total morphine consumption	If the pain score more than or equal to 4), opioid (morphine) 0.5 to 1 mg/kg will be given and total dose will be calculated	24 hours postoperatively
Incidence of postoperative complications	Incidence of postoperative complications such as hypotension, nausea and vomiting will be recorded.	24 hours postoperatively

Collaborators and Investigators

• Sponsor: Menoufia University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2025
• Primary Completion (Actual): June 1, 2026
• Study Completion (Actual): June 1, 2026

Study Registration Dates

• First Submitted: September 23, 2026
• First Submitted That Met QC Criteria: September 23, 2026
• First Posted (Actual): September 30, 2026

Study Record Updates

• Last Update Posted (Actual): September 30, 2026
• Last Update Submitted That Met QC Criteria: September 23, 2026
• Last Verified: September 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Organic Chemicals; Heterocyclic Compounds, 1-Ring; Heterocyclic Compounds; Azoles; Imidazoles; Anilides; Amides; Aniline Compounds; Amines; Behavioral Disciplines and Activities; Digestive System and Oral Physiological Phenomena; Behavioral Sciences; Dentistry; Dental Physiological Phenomena; Bupivacaine; Dexmedetomidine; Dental Occlusion; Parapsychology
• Other Study ID Numbers: 12/2024 ANET 32

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

IPD Plan Description

The data will be available upon a reasonable request from the corresponding author after the end of study for one year.

IPD Sharing Time Frame

After the end of study for one year.

IPD Sharing Access Criteria

The data will be available upon a reasonable request from the corresponding author.

• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No